I am so glad I caught this. I almost made a critical mistake with the provisional restorations for a case I completed earlier this year.

The upper provisional was completed, I thought it looked excellent and went to take a few pictures of it before seating and right there through the camera viewfinder I saw it.

Can you see what is wrong with this provisional?

I left the gingival embrasure between the central incisors closed!

This could have blunted the papilla and left a black triangle at insert (along with an unhappy patient).

Now, as we know from Dr. Dennis Tarnow if the contact point of the restorations is 5.0 mm or less from the interdental peak of bone the papilla will reform.

That is great long term but the patient would not be happy short term. Therefore, I recommend in my trainings to design and contour the gingival embrasures of the provisional to provide space for the papilla.

Here is ideal papilla contour after the removal of long-term provisional restorations. The cement you see on the preparations is Durelon. I use this for long-term provisional restorations but it adheres to tooth structure a little and I remove it with an ultrasonic scaler.

Several different instruments can be used to create ideal gingival embrasure form with your provisional restorations. I like the Vision Flex discs from Brasseler and/or a 7901 carbide to carve the ideal embrasure form.

These ultrathin discs are excellent to define precise embrasure form.

I recommend you instruct your dental assistants to be careful how they handle them for cleaning and sterilization because they are expensive and if they get even a small bend on one corner they do not cut with the same precision and are basically useless.

So, with this new case, I saw the poor embrasure form while I was taking pictures and corrected it.

Here is the final provisional contour the day I seated them.

Here is an composite image showing the initial provisional with the poor embrasure form first. The middle image represents the adjusted provisional embrasure form after shaping with the 7901 carbide and the final seated image shows the provisional with a knife edge type of embrasure form created from the Vision Flex disc.

Here they are a few weeks later when the tissue was healed.

Here are the final restorations immediately after bonding.

Here are the final restorations after 4 months of healing. Note the excellent tissue health and contour. I am glad I caught that mistake I almost committed with the provisional restoration.

The ceramics were created by Master Ceramist Harald Heindl.

If you would like to see this new case in detail with examples of the preparations for Occlusal Veneers, Veneer Crowns, and Onlay Veneers please register for my new webinar while it is still available.

As clinicians we are often faced with the dilemma of trying to balance material and lab needs with the desire to be conservative.

Would you prefer to be safe and provide the lab with plenty of reduction so the material is strong and the resulting thickness makes it easier to create a desired esthetic result?

Here is a picture for the ceramics from a recent case I completed.

Notice the thickness of the central incisor crowns compared to the lateral incisors!

The central incisors were originally prepared by a different clinician with a more traditional preparation design and a butt joint margin.

Unfortunately, this leads to what I would refer to as Strong Restoration VS Strong Tooth.

Notice the lateral incisor crowns. These are prepared with a different philosophy that I would refer to as Strong Tooth VS Strong Restoration.

Here is the preparation photo.

The important question to ask is, “can we have both?”

I believe the answer is yes. I feel with the predictable ability to either bond directly to enamel or use IDS to predictably bond to exposed dentin you can achieve Strong Tooth AND Strong Restoration!

I do not believe we need excessive reduction of healthy tooth structure to achieve our long-term goals. We can bond a thinner thickness of ceramic leading to less reduction of healthy tooth and stronger remaining teeth while still achieving excellent esthetics and predictable results.

This leads to some exciting preparation designs even with erosion patients like you see in the picture below.

We can use Occlusal Veneers, Veneer Crowns, and Onlay Veneers to help restore a patient like this with severe erosion in a more conservative manner.

If you would like to see this new case in detail and examples of Occlusal Veneers, Veneer Crowns, and Onlay Veneers please register for my new webinar while it is still available.

In this new video, I talk about occlusal veneers to open the vertical dimension for wear patients that may not require full coverage restorations for the molars.

During the video, I share with you images from two cases I completed in my practice. The first case was finished 13 years ago but I saw him this week during his hygiene appointment and I included new 13-year post op photos taken Wednesday.

The second case was completed this year in my practice.

Thank you again for being a member of my online community and remember…

You can do this kind of dentistry!

I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,

Stephen

P.S. If you are interested in this kind of dentistry, I believe you would enjoy my Online Seminar. Altering the Vertical Dimension Case Studies.

This seminar will feature 3 detailed case studies teaching a different vertical dimension concept for each case. These case studies are from patients that I have successfully treated in my own practice over the past 21 years.

The first case study is the 13-year-old case from my new Dental Excellence video so you can be confident these techniques work in a regular clinical practice.

Welcome to my blog. This is the 20th video from my Dental Excellence video series.

In this new video, I teach you one critical factor for excellent anterior provisional restorations and ask you “What is wrong with this provisional?”

Thank you again for being a member of my online community and remember…

You can do this kind of dentistry!

I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

P.S. If you’d like to see additional clinical videos teaching how I create my anterior provisional restorations as well as how I create veneer provisionals and anterior implant provisional restorations I have a new online seminar you can join.

This seminar is called Precision Provisional Techniques For Porcelain Veneers, Anterior Dental Implants And Rehabilitation Cases.

If you are interested in this kind of dentistry, I believe you will enjoy this new online seminar.

In this New Dental Excellence Video I will share with you a very cool root extraction system.

This new training will use extensive video footage filmed with my Zeiss dental microscope to teach you this simple but highly effective extraction technique.

Thank you again for being a member of my online community and remember.

You can do this kind of dentistry!

I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

P.S. All of us have patients that suffer from tooth wear in our practices. During this new Dental Excellence video I also tell you about my Altering the Vertical Dimension Case Studies Online Seminar.

If you are interested in this kind of dentistry CLICK HERE to register and find out more about this new seminar presentation.

P.P.S. We all know the importance of the diagnostic wax-up. When you attend my new online seminar I have a special bonus for you. At the 5-minute mark I have created a link to download my New Diagnostic Wax-up Instructions PDF to use with your cases!

You have to log in and attend the seminar to receive this download.

Click Here to register for this new seminar this weekend, Altering the Vertical Dimension Case Studies and receive this Free Download when you log in.

In this New Dental Excellence Video I will teach you the overall system I follow to help patients with more complex dentistry select appropriate treatment plans.

I will tell you about a new patient that I recently completed the diagnostic records for that is going ahead with a full mouth rehabilitation.

I have edited my recent Facebook Live presentation to use a multi-video camera presentation that I think you will enjoy!

Near the end of this new video I take you on a tour of my large operatory and show you my microscope, loupes, piezo, cameras and laser. This is the operatory I prepare my full mouth rehab cases in. ☺

Thank you again for being a member of my online community and remember, you can do this kind of dentistry! I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best,
Stephen

P.S. To learn more details about presenting fees for these cases and to see the actual case presentation slides for a full mouth rehabilitation consultation join me for my Master Your Case Acceptance Webinar by clicking this link to register https://www.phelandentalseminars.com/myca-reg

In this New Dental Excellence training I would like to share with you a new clinical video I filmed with my Zeiss microscope teaching you how I use ultrasonic diamond tips for the precision preparation of class 2 box forms.

Near the end of this video I tell you about my new clinical tutorial: Creating Stunning Provisionals. Click here to learn more.

Thank you again for being a member of my online community and remember, you can do this kind of dentistry! I believe that beautiful dentistry with precise fit and occlusion is not just for the gurus.

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Phone: (905) 989-1169
Phone: (800) 964-1619
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About Me

Dr. Stephen Phelan graduated from the University of Toronto, Faculty of Dentistry in 1992. He has lectured locally and internationally on the subject of dental implants, occlusion, esthetic and restorative dentistry.